Orthorexia…When Being Healthy Becomes Unhealthy

The term “Orthorexia Nervosa,” first coined by Steven Bratman, MD, in his book Health Food Junkies, refers to an obsession with eating only foods perceived to be of a certain status in terms of health, calories, or origin. The disorder is characterized by anxiety, ritualistic thoughts and behaviors, and excessive pickiness with food. Though not officially recognized by the DSM (Diagnostic and Statistical Manual of Mental Disorders), Orthorexia Nervosa is a serious mental condition that can significantly impair one’s life and daily functioning. In the below excerpt, Bratman describes how healthy eating, like anything else, can become unhealthy when it is taken to the extreme:

Twenty years ago I was a wholehearted, impassioned advocate of healing through food. In those days I was a cook and organic farmer at a large commune in upstate New York. Today, as a physician who practices alternative medicine, I still almost always recommend dietary improvement to my patients. How could I not? A low-fat, semi-vegetarian diet helps prevent nearly all major illnesses, and more focused dietary interventions can dramatically improve specific health problems. But I’m no longer the true believer in nutritional medicine I used to be.

Where once I was enthusiastically evangelical, I’ve grown cautious. I can no longer console myself with the hope that one day a universal theory of eating will be discovered that can match people with the diets right for them. And I no longer have faith that dietary therapy is a uniformly wholesome intervention. I have come to regard it as I do drug therapy: as a useful treatment with serious potential side effects.

My disillusionment began in the old days at the commune. As staff cook I was required to prepare several separate meals at once to satisfy the insistent and conflicting demands of our members. All communes attract idealists; ours attracted food idealists. On a daily basis I encountered the chaos of contradictory nutritional theories.

Our main entrée was always vegetarian, but a vocal subgroup insisted we serve meat. Since many vegetarians would not eat from pots and pans contaminated by fleshly vibrations, the meat had to be cooked in a separate kitchen.

We cooks also had to satisfy the vegans, who eschewed all milk and egg products. The rights of the Hindu-influenced crowd couldn’t be neglected either. They insisted we omit the onion-family foods, which, they believed, provoked sexual desire.

For the raw-foodists we always laid out trays of sliced raw vegetables, but the macrobiotic adherents looked at these offerings with disgust. They would only eat cooked vegetables. Furthermore, they believed that only local, in-season vegetables should be eaten, which led to frequent and violent arguments about whether the commune should spend its money on lettuce in January.

After watching these food wars for a while, I began to fantasize about writing a cookbook for eating theorists. Each food would come complete with a citation from one system or authority claiming it to be the most divine edible ever created; a second reference, from an opposing view, would damn it as the worst pestilence one human being ever fed to another.

Finding examples wouldn’t be difficult. I could pit the rules of various food theories against each other: Spicy food is bad; cayenne peppers are health-promoting. Fasting on oranges is healthy; citrus fruits are too acidic. Milk is good only for young cows (and pasteurized milk is even worse); boiled milk is the food of the gods. Fermented foods, such as sauerkraut, are essentially rotten; fermented foods aid digestion. Sweets are bad; honey is nature’s most perfect food. Fruits are the ideal food; fruit causes candida. Vinegar is a poison; apple cider vinegar cures most illnesses. Proteins should not be combined with starches; aduki beans and brown rice should always be cooked together.

Dietary methods of healing are often offered in the name of holism, one of the strongest ideals of alternative medicine. No doubt alternative health practitioners are compensating for the historical failure of modern medicine to take dietary treatment seriously enough. But by focusing single-mindedly on diet, such practitioners end up advocating a form of medicine as lacking in holistic perspective as the more traditional approaches they attempt to correct. It would be far more holistic to try to understand other elements in the patient’s life before making dietary recommendations, and occasionally to temper those recommendations with that understanding.